DeBakey IIIb aortic dissection associated with thoracic aneurysm was successfully operated upon in a 59-year-old man. The patient had sudden onset of severe back pain and pain in the left lower extremity and dissection associated with thoracic aneurysm was diagnosed. During the operation, we used partial cardiopulmonary bypass support with cannulation of the pulmonary and femoral artery. The entry of the dissection was in a true aneurysm of the descending aorta, and it was replaced with a 22mm Hemashield prosthetic graft. Aortic dissection, with entry in the true aneurysm is rare and is of high risk for rupture.

There are few reports on the long term efficacy of surgery for endocardial cushion defect (ECD) in elderly patients. We report a case with a successful course after ECD operation. A 70-year-old man was admitted with incomplete ECD, grade III mitral and tricuspid regurgitation, pulmonary hypertension and atrial fibrillation. The operative procedures included direct closure of the mitral cleft, pericardial patch closure for the ostium primum defect, direct closure of the tricuspid cleft and tricuspid annuloplasty. Pulmonary hypertension was improved after the operation, and he was discharged on the 41st day after the operation. Now, 3 years and 6 months after the operation, he has maintained an improved quality of life (QOL) with an uneventful postoperative course. The present report may suggest one solution for the long term effective treatment by operation for elderly patients who suffer from ECD, especially to achieve better QOL.

1)We reproduced a problem–based learning (PBL) tutorial at our school and developed our own PBL tutorial, which we call "Fujita–style PBL." This is a clinical problem-solving type of PBL, in which both a monitoring room and small–group learning rooms are used.
2)To maintain the present number of PBL lessons despite the limited number of tutors, one tutor supervises several groups simultaneously. Coordinators observe the progress of PBL from a monitoring room and support the tutors.
3)Students learn the given scenario and identify their learning issues. After they study the learning issues by themselves, the students return to tutorials to explain their learning issues. Thereafter, each group's findings are presented to the groups supervised by one tutor.